Views entirely my own and do not represent anyone else. RT does not mean agree. Apologies for typos.

Joined March 2024
๐Ÿ“ฐ What can we learn from the LivR Well trial? A negative trial can still change how we design the next one. In LivR Well, home-based care didn't beat enhanced standard care for decompensated cirrhosis, but patients in both arms did better than expected. ๐Ÿ”‘ Key findings: โค๏ธ 6-month mortality was 13%, against the roughly 30% expected for a baseline MELD of 18.5 ๐Ÿ”„ At 12 weeks, about 4 in 10 patients in each arm were compensated (21/54 vs 18/51) ๐Ÿงฉ Trial delivery was hard: recruitment fell short of the planned 320, 20 patients dropped out, and only 41/105 completed all quality-of-life surveys ๐ŸŽฏ The authors propose patient-centred endpoints for future trials, such as days spent at home, symptoms and quality of life ๐Ÿ’ก Liver nurse-coordinated multidisciplinary care may help everyone it reaches. The challenge is designing trials that can capture that benefit. Read the full paper ๐Ÿ”— fg.bmj.com/content/early/202โ€ฆ @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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๐Ÿšจ ๐Ÿšจ New in Frontline Gastroenterology Gurusamy et al compared recommendations in 9 AASLD, BSG, EASL and NICE guidelines with the findings of 7 Cochrane reviews. The reviews covered variceal bleeding, SBP, ascites and hepatorenal syndrome. ๐Ÿ”‘ Key findings: ๐Ÿ“‹ 62 guideline statements overlapped with the Cochrane reviews ๐Ÿค Guidelines and Cochrane-derived recommendations agreed on only 14.5% (95% CI 7.7% to 25.6%) ๐Ÿ’ช Most disagreements were about how strongly to recommend, not what to recommend. Guidelines consistently rated recommendations as stronger than the evidence suggested. โŒ 4 statements were unsupported outright: midodrine for refractory ascites, primary SBP prophylaxis, and pre-emptive TIPS (in 2 guidelines) ๐Ÿ“… Differences in search dates didnโ€™t explain the discordance Read the full paper ๐Ÿ”— fg.bmj.com/content/early/202โ€ฆ @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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๐ŸŽง Have you listened to the #FGPodcast? Authors and leading experts in gastroenterology, hepatology and nutrition discuss the papers behind best practice. Latest episode: practical approaches to fatigue in IBD. Listen now ๐Ÿ‘‡ fgbmj.podbean.com/
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Many congratulations to Dr Chris Black @DrCJBlack and Dr Nuru Noor @Y_ECCO_IBD on their #UEGRisingStars2026 @my_ueg awards. Chris and Nuru are exceptional clinical academics and we are very proud that both are excellent @FrontGastro_BMJ Lead Associate Editors! @BritSocGastro @Gut_BMJ @BMJOpen_Gastro @PhilSmithIsBack @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman @alex_ford12399 #UEGweek #UEGWeek2026 #UEG2026
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๐ŸŽฅ Captured something special on your last list? Share it with Frontline Gastroenterology! We're looking for endoscopy video articles featuring new techniques, practical tips, unusual findings and creative solutions in GI endoscopy. Get started today ๐Ÿ‘‡ fg.bmj.com/pages/authors#vidโ€ฆ
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๐Ÿšจ ๐Ÿšจ New article in Frontline Gastroenterology Srinivasa et al linked national cancer registry and HES data for 56,827 people diagnosed with oesophageal cancer in England between 2018 and 2024. They asked how many had their oesophagus dilated for a stricture in the 2 years before the cancer was diagnosed. ๐Ÿ”‘ Key findings: 1๏ธโƒฃ About 1 in 80 (1.2%) had dilatation before diagnosis, and in 36.4% this was more than 3 months before โš ๏ธ Dilatation was more likely in women, in squamous cell carcinoma and with more comorbidity ๐Ÿ’ฅ 3.9% had a perforation, with higher risk in women and after 4 or more dilatations ๐Ÿ” 51.7% had no endoscopic follow-up after dilatation, and follow-up was linked to less advanced cancer at diagnosis ๐Ÿ’ก Characterise strictures with image-enhanced endoscopy and adequate biopsies before dilating. Re-biopsy strictures that respond poorly, and build follow-up into stricture pathways. Read the full paper ๐Ÿ”— fg.bmj.com/content/early/202โ€ฆ @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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๐Ÿšจ ๐Ÿšจ New in Frontline Gastroenterology Machta et al compared diagnostic yield for first diagnostic paediatric endoscopy at a London tertiary centre across three eras: 2014, the COVID-19 restrictions, and 2022โ€“23. COVID-era capacity limits forced stricter patient selection, and that shift persisted afterwards. ๐Ÿ”‘ Key findings: ๐Ÿ“ˆ Histological abnormality rose from 36% to 66.4% (194 procedures in 137 children) ๐Ÿ”ฌ For OGD alone in children with negative coeliac serology, it rose from 16% to 54.9% ๐Ÿฉบ For OGD plus ileocolonoscopy, it rose from 47% to 75% ๐Ÿ›ก๏ธ There was no observed evidence of harm from more selective referral ๐Ÿ”Ž Endoscopic impression had a PPV of 83.8% but an NPV of only 57.9%, so routine biopsy still matters ๐Ÿ’ก The authors propose diagnostic yield as a national benchmark and quality standard for paediatric endoscopy services. Read the full paper ๐Ÿ”— fg.bmj.com/content/early/202โ€ฆ @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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Response to @RCPhysicians ask re @lengreview clinical protocol done- as a Fellow of RCP. I believe in transparency- so here are my views on some of the key questions. In summary? Needs a rejection on key areas of PAs seeing undifferentiated patients. And certainly not lean on Gen Next to be liability sponge. And let @rcgp make their own decisions regards primary care- no need to interfere. NB: Don't like it, give a counter view. Don't abuse or be snarky. It's a democracy- it's my view. You are welcome to give yours. @mmamas1973 @djnicholl @Mumtaz_Patel_1 @OGMustafa @BDChadwick Link: nhssugardoc.blogspot.com/202โ€ฆ
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Unregulated expansion of PAs started in 2015 It took 10 years to finally get the Leng Review 15m after being published it is still not being followed, sadly there are some who are still pushing for undiagnosed (undifferentiated) patients to be seen first by PAs in GP practices0
Physician Assistants were first muted as an idea an concept in the early 2010s as a way of alleviating the workforce shortage in General Practice, helping GPs deal with some of the more simple and mundane tasks to allow GPs more time for patients.ย  A ๐Ÿงต rcp.ac.uk/media/ffdai1fx/comโ€ฆ
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Many congratulations to Dr Chris Black @DrCJBlack and Dr Nuru Noor @Y_ECCO_IBD on their #UEGRisingStars2026 @my_ueg awards. Chris and Nuru are exceptional clinical academics and we are very proud that both are excellent @FrontGastro_BMJ Lead Associate Editors! @BritSocGastro @Gut_BMJ @BMJOpen_Gastro @PhilSmithIsBack @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman @alex_ford12399 #UEGweek #UEGWeek2026 #UEG2026
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A reminder to @RCPhysicians about what Fellows voted for in an EGM IN 2024 And how data was presented- with it's subsequent fall out due to data manipulation- resulting in resignations Lessons from the past: 1. Don't manipulate responses to suit a narrative. 2. Don't ignore Fellows and their views by use of 'process' Yes- standing by that narrative cost me- yet I haven't budged an inch from that philosophy. Less Chicanery, More Leadership. I repeat: The @lengreview clinical protocols for PAs should be rejected -if nothing else- on grounds of presumed COI by contributors. Also- PAs should NOT be seeing undifferentiated patients. Full stop. @Mumtaz_Patel_1 @OGMustafa @HilaryWMedic
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๐Ÿ“ฐ New article in Frontline Gastroenterology Ngu et al report LivR Well, a randomised controlled trial from Monash Health in Melbourne. It tested a 28-day multidisciplinary, home-based programme for people with hepatic decompensation. The programme included home nursing and physiotherapy, plus hepatologist, dietitian, pharmacist and addiction medicine input. It was compared with enhanced standard ambulatory care. ๐Ÿ”‘ Key findings: ๐Ÿ‘ฅ 105 patients were randomised (54 intervention, 51 control) ๐Ÿฅ 30-day liver-related emergency admissions did not differ: 24% vs 25% (IRR 0.92, 95% CI 0.39 to 2.16) ๐Ÿ“‰ MELD improved in both groups, by about 3.4 to 3.9 points ๐Ÿ’ฌ Quality of life improved similarly in both groups ๐Ÿ’ฐ The programme wasn't cost-effective (modelled ICER A$145K/QALY vs an A$50K threshold) ๐Ÿ’ก Both arms had a liver nurse, a direct mobile line and day-ward access. This enhanced "standard care" may explain why no difference was detected. Read the full paper ๐Ÿ”— fg.bmj.com/content/early/202โ€ฆ @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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Interesting admission from one of my least favourite accounts. Back when I first heard about ACP, it was the older, battle-hardened nurses who were obtaining extra skills and making a difference. I was shown examples of where this really augmented team working. I kind of /
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You have to love the fact that it's been 18 months since this started @NHSE_WTE And there are still focus groups running on this... While we await a report which will confirm that the Pope is indeed Catholic. And lots of things will be said, asked and pontificated over. But without any funding- thus based on love, vibes and prayers. Incoming...soon. Then again, it comes from the stable of those who categorically stood against Motion 5 of the @RCPhysicians EGM passing. Evans, Powis, McLeod, Dacre, Whitty et al. Reminder of that motion 5: "Demand of a formal pause or slow-down in the deployment and recruitment of PAs until wider medico-legal issues, regulation standards, and exact scopes of practice are legally resolved" History is such a lovely thing. @djnicholl @mmamas1973 @Shr_Nottingham @dieracg @Dr_Done_ @PhilSmithIsBack @G_D_Phillips1
Today we have started a review of postgraduate medical training led by @NHSEnglandNMD and @CMO_England Listen to @NavinaEvans explaining more. Find out more at england.nhs.uk/postgraduate-โ€ฆ
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๐Ÿ“ฐ Out now in the November issue of Frontline Gastroenterology Danso et al give a practical guide to managing fatigue in IBD, designed for clinicians without a full multidisciplinary team. ๐Ÿ”‘ Fatigue affects 72% of patients with active IBD and 47% in remission. A 5-step algorithm covers screening, reversible causes, sleep and activity, and alerting medications. Modafinil looks promising in refractory cases. ๐ŸŽง Listen to the related #FGPodcast via the FG homepage. ๐Ÿ”— doi.org/10.1136/flgastro-202โ€ฆ @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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Working on the feedback as Fellow to @RCPhysicians - regards the @lengreview protocols for PA working Unless I have read it wrong? The RCP has included a few questions on primary care, whether itโ€™s ok for PAs to see undifferentiated patients, what exceptions should apply - and asking for views of RCP Fellows. In my view? 1. The @rcgp have stated PAs have no role in primary care. It is up to THEM to change that and decide whatโ€™s right or wrong in primary care 2. Itโ€™s not the business of @RCPhysicians (I think) to interfere in primary care working - we should focus on what we can influence - eg: Should PAs be doing Lumbar Punctures & Peritoneal drains. Or seeing undifferentiated patients with mythical levels of supervision @Mumtaz_Patel_1 @OGMustafa @djnicholl @mmamas1973 @Azeem_Majeed @trishgreenhalgh @VictoriaTzB @BMA_GP
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Phil Smith retweeted
Cutting doctorsโ€™ pay wonโ€™t keep them in the NHS. The DDRB must show its independence and recommend what patients and the NHS need, not what the Government is prepared to pay. Full statement: bma.org.uk/bma-media-centre/โ€ฆ
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๐Ÿ“ฐ New review in the November issue of Frontline Gastroenterology Abuquteish et al review lower GI toxicity from immune checkpoint inhibitors and targeted cancer therapies, covering clinical, endoscopic and histological features. ๐Ÿ”‘ Anti-CTLA-4 causes earlier and more severe colitis than anti-PD-1/PD-L1, and colitis was reported in about 25% of patients on combined ipilimumab and nivolumab. Rituximab was linked to a roughly sixfold increased risk of developing IBD. ๐Ÿ”— doi.org/10.1136/flgastro-202โ€ฆ @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
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Phil Smith retweeted
It is a basic principle of American democracy that the government canโ€™t selectively target individuals simply because of their political beliefs or what they say. But thatโ€™s exactly what the Trump Administration is doing to Congresswoman Ilhan Omar of Minnesota. To understand why this is so appalling, itโ€™s important to know the facts. Congresswoman Omar came to this country with her father when she was 12 years old. Five years later, her father became a naturalized citizen. If Ilhan had been 18 at the time, she would have had to apply for citizenship separately. But because she was 17, she became a naturalized citizen automatically. Congresswoman Omar went on to graduate from college, work as a community organizer, become the first Somali-American legislator elected to public office in the U.S., and win a seat in Congress. There, she has been one of the Trump Administrationโ€™s fiercest critics, which has led the president to repeatedly single her out as someone who he believes does not belong in this country. Now the Administration is actively trying to deport Congresswoman Omar, seemingly based solely on the unsubstantiated theory that she was actually 18 when her father was naturalized, and therefore is not a citizen. Federal agents have raided her home, confiscated personal records, and seized her phone โ€” all to try and uncover a nonexistent smoking gun from 20 years ago that will somehow make their case. Think about that. The full weight of the federal government is being brought down on a law-abiding elected official because she has dared to criticize the president. And itโ€™s not the first time this has happened. Under President Trump, the Justice Department has repeatedly gone after those he considers his political enemies โ€” from the Attorney General of New York, to the former head of the FBI, to members of the Federal Reserve. In those cases, the prosecutions either stalled or were dismissed for having no basis in law, and the same is likely to happen in this case. But not before Congresswoman Omarโ€™s life has been turned upside down, her legal bills have piled up, and sheโ€™s been forced to spend time fighting unsubstantiated charges instead of serving the people of Minnesota. The fact that any president, or any administration, is willing to engage in such transparent efforts to intimidate someone should outrage all Americans, regardless of how they feel about Congresswoman Omarโ€™s political views. Because if this becomes the new normal, thereโ€™s no reason to believe it will stop with her โ€” or that future presidents, in either party, wonโ€™t do the same.
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